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Deirdre J. Murphy - One of the best experts on this subject based on the ideXlab platform.

  • Risk factors and morbidity associated with suboptimal instrument placement at Instrumental Delivery: observational study nested within the Instrumental Delivery & Ultrasound randomised controlled trial ISRCTN 72230496
    BJOG : an international journal of obstetrics and gynaecology, 2014
    Co-Authors: Meenakshi Ramphul, Mairead Kennelly, Gerard Burke, Deirdre J. Murphy
    Abstract:

    Objectives To identify risk factors and morbidity associated with suboptimal instrument placement at Instrumental Delivery. Design Observational study, nested within a randomised controlled trial. Setting Two university-affiliated maternity hospitals. Sample A cohort of 478 nulliparous women at term (≥37 weeks of gestation) undergoing Instrumental Delivery. Methods Univariable and multivariable logistic regression analyses were performed. Main outcome measures Risk factors for suboptimal application of vacuum or forceps, maternal and neonatal morbidity, and the sequential use of instruments, second operator, and caesarean section following failed Instrumental Delivery. Results Instrument placement was suboptimal in 138 of 478 (28.8%) deliveries. Factors associated with suboptimal instrument placement included fetal malposition (OR 2.44, 95% CI 1.62–3.66), mid-cavity station (OR 1.68, 95% CI 1.02–2.78), and forceps as the primary instrument (OR 2.01, 95% CI 1.33–3.04). Compared with optimal instrument placement, suboptimal placement was associated with prolonged hospital stay (adjusted OR 2.28, 95% CI 1.30–4.02) and neonatal trauma (adjusted OR 4.25, 95% CI 1.85–9.72). Suboptimal placement was associated with a greater use of sequential instruments (adjusted OR 3.99, 95% CI 1.94–8.23) and caesarean section for failed Instrumental Delivery (adjusted OR 3.81, 95% CI 1.10–13.16). The mean decision to Delivery interval (DDI) was 4 minutes longer in the suboptimal group (95% CI 2.1–5.9 minutes). Conclusions Suboptimal instrument placement is associated with increased maternal and neonatal morbidity and procedural complications. Greater attention should be focused on instrument placement when training obstetricians for Instrumental Delivery.

  • Study Protocol. IDUS - Instrumental Delivery & ultrasound. A multi-centre randomised controlled trial of ultrasound assessment of the fetal head position versus standard care as an approach to prevent morbidity at Instrumental Delivery
    BMC pregnancy and childbirth, 2012
    Co-Authors: Deirdre J. Murphy, Gerard Burke, Alan A Montgomery, Meenakshi Ramphul
    Abstract:

    Background: Instrumental deliveries are commonly performed in the United Kingdom and Ireland, with rates of 12 – 17% in most centres. Knowing the exact position of the fetal head is a pre-requisite for safe Instrumental Delivery. Traditionally, diagnosis of the fetal head position is made on transvaginal digital examination by delineating the suture lines of the fetal skull and the fontanelles. However, the accuracy of transvaginal digital examination can be unreliable and varies between 20% and 75%. Failure to identify the correct fetal head position increases the likelihood of failed Instrumental Delivery with the additional morbidity of sequential use of instruments or second stage caesarean section. The use of ultrasound in determining the position of the fetal head has been explored but is not part of routine clinical practice. Methods/Design: A multi-centre randomised controlled trial is proposed. The study will take place in two large maternity units in Ireland with a combined annual birth rate of 13,500 deliveries. It will involve 450 nulliparous women undergoing Instrumental Delivery after 37 weeks gestation. The main outcome measure will be incorrect diagnosis of the fetal head position. A study involving 450 women will have 80% power to detect a 10% difference in the incidence of inaccurate diagnosis of the fetal head position with two-sided 5% alpha. Discussion: It is both important and timely to evaluate the use of ultrasound to diagnose the fetal head position prior to Instrumental Delivery before routine use can be advocated. The overall aim is to reduce the incidence of incorrect diagnosis of the fetal head position prior to Instrumental Delivery and improve the safety of Instrumental deliveries.

  • study protocol idus Instrumental Delivery ultrasound a multi centre randomised controlled trial of ultrasound assessment of the fetal head position versus standard care as an approach to prevent morbidity at Instrumental Delivery
    BMC Pregnancy and Childbirth, 2012
    Co-Authors: Deirdre J. Murphy, Gerard Burke, Alan A Montgomery, Meenakshi Ramphul
    Abstract:

    Background: Instrumental deliveries are commonly performed in the United Kingdom and Ireland, with rates of 12 – 17% in most centres. Knowing the exact position of the fetal head is a pre-requisite for safe Instrumental Delivery. Traditionally, diagnosis of the fetal head position is made on transvaginal digital examination by delineating the suture lines of the fetal skull and the fontanelles. However, the accuracy of transvaginal digital examination can be unreliable and varies between 20% and 75%. Failure to identify the correct fetal head position increases the likelihood of failed Instrumental Delivery with the additional morbidity of sequential use of instruments or second stage caesarean section. The use of ultrasound in determining the position of the fetal head has been explored but is not part of routine clinical practice. Methods/Design: A multi-centre randomised controlled trial is proposed. The study will take place in two large maternity units in Ireland with a combined annual birth rate of 13,500 deliveries. It will involve 450 nulliparous women undergoing Instrumental Delivery after 37 weeks gestation. The main outcome measure will be incorrect diagnosis of the fetal head position. A study involving 450 women will have 80% power to detect a 10% difference in the incidence of inaccurate diagnosis of the fetal head position with two-sided 5% alpha. Discussion: It is both important and timely to evaluate the use of ultrasound to diagnose the fetal head position prior to Instrumental Delivery before routine use can be advocated. The overall aim is to reduce the incidence of incorrect diagnosis of the fetal head position prior to Instrumental Delivery and improve the safety of Instrumental deliveries.

  • Strategies to enhance assessment of the fetal head position before Instrumental Delivery: a survey of obstetric practice in the United Kingdom and Ireland
    European journal of obstetrics gynecology and reproductive biology, 2012
    Co-Authors: Meenakshi Ramphul, Yvonne O’brien, Deirdre J. Murphy
    Abstract:

    Abstract Objective To establish the current practice of obstetricians with regard to assessment of women in labour before Instrumental Delivery. Study design A national postal survey of obstetricians in consultant-led obstetric units in the United Kingdom and Ireland. Clinical assessment before Instrumental Delivery, factors associated with difficulty in determining the fetal head position, approaches used to enhance determination of the fetal head position, perceived accuracy rates in assessment of the fetal head position and willingness to participate in a clinical trial of ultrasound assessment of the fetal head position before Instrumental Delivery were explored. Results The response rate was 75%. The majority of obstetricians assess women clinically before Instrumental Delivery as recommended by guidelines. Both consultants and trainees reported the following factors as being associated with difficulty in diagnosing the fetal head position: inadequate maternal pain relief, fetal caput and clinical inexperience. Strategies used when experiencing difficulty in determining the fetal head position varied, with trainees more likely than consultants to seek a second opinion (40% vs. 5%, p p =0.048) or abandon the procedure in favour of caesarean section (14% vs. 6%, p =0.035). One in five obstetricians reported using abdominal ultrasound to aid diagnosis, with some consultants reporting the use of ultrasound as ‘a great idea' and others being ‘appalled'. One in eight consultants perceived that they made an incorrect diagnosis of the fetal head position at Instrumental Delivery in more than 10% of deliveries compared to one in four trainees. Conclusion The contrasting views on the role of ultrasound to enhance the assessment of the fetal head position before Instrumental Delivery suggest that it should be evaluated in a randomised clinical trial.

  • pelvic floor morbidity at 3 years after Instrumental Delivery and cesarean Delivery in the second stage of labor and the impact of a subsequent Delivery
    American Journal of Obstetrics and Gynecology, 2005
    Co-Authors: Rachna Bahl, Bryony Strachan, Deirdre J. Murphy
    Abstract:

    Objective To compare pelvic floor symptoms at three years following Instrumental Delivery and cesarean section in the second stage of labor and to assess the impact of a subsequent Delivery. Study design We conducted a prospective cohort study of 393 women with term, singleton, cephalic pregnancies who required Instrumental vaginal Delivery in theatre or cesarean section at full dilatation between February 1999 and February 2000. 283 women (72%) returned postal questionnaires at three years. Results Urinary incontinence at three years post Delivery was greater in the Instrumental Delivery group as compared to the cesarean section group (10.5% vs 2.0%), OR 5.37 (95% CI, 1.7, 27.9). There were no significant differences in ano-rectal or sexual symptoms between the two groups. Pelvic floor symptoms were similar for women delivered by cesarean section after a failed trial of Instrumental Delivery compared to immediate cesarean section. A subsequent Delivery did not increase the risk of pelvic floor symptoms at three years in either group. Conclusion An increased risk of urinary incontinence persists up to three years following Instrumental vaginal Delivery compared to cesarean section in the second stage of labor. However, pelvic floor symptoms are not exacerbated by a subsequent Delivery.

Meenakshi Ramphul - One of the best experts on this subject based on the ideXlab platform.

  • Risk factors and morbidity associated with suboptimal instrument placement at Instrumental Delivery: observational study nested within the Instrumental Delivery & Ultrasound randomised controlled trial ISRCTN 72230496
    BJOG : an international journal of obstetrics and gynaecology, 2014
    Co-Authors: Meenakshi Ramphul, Mairead Kennelly, Gerard Burke, Deirdre J. Murphy
    Abstract:

    Objectives To identify risk factors and morbidity associated with suboptimal instrument placement at Instrumental Delivery. Design Observational study, nested within a randomised controlled trial. Setting Two university-affiliated maternity hospitals. Sample A cohort of 478 nulliparous women at term (≥37 weeks of gestation) undergoing Instrumental Delivery. Methods Univariable and multivariable logistic regression analyses were performed. Main outcome measures Risk factors for suboptimal application of vacuum or forceps, maternal and neonatal morbidity, and the sequential use of instruments, second operator, and caesarean section following failed Instrumental Delivery. Results Instrument placement was suboptimal in 138 of 478 (28.8%) deliveries. Factors associated with suboptimal instrument placement included fetal malposition (OR 2.44, 95% CI 1.62–3.66), mid-cavity station (OR 1.68, 95% CI 1.02–2.78), and forceps as the primary instrument (OR 2.01, 95% CI 1.33–3.04). Compared with optimal instrument placement, suboptimal placement was associated with prolonged hospital stay (adjusted OR 2.28, 95% CI 1.30–4.02) and neonatal trauma (adjusted OR 4.25, 95% CI 1.85–9.72). Suboptimal placement was associated with a greater use of sequential instruments (adjusted OR 3.99, 95% CI 1.94–8.23) and caesarean section for failed Instrumental Delivery (adjusted OR 3.81, 95% CI 1.10–13.16). The mean decision to Delivery interval (DDI) was 4 minutes longer in the suboptimal group (95% CI 2.1–5.9 minutes). Conclusions Suboptimal instrument placement is associated with increased maternal and neonatal morbidity and procedural complications. Greater attention should be focused on instrument placement when training obstetricians for Instrumental Delivery.

  • Instrumental Delivery and ultrasound a multicentre randomised controlled trial of ultrasound assessment of the fetal head position versus standard care as an approach to prevent morbidity at Instrumental Delivery
    British Journal of Obstetrics and Gynaecology, 2014
    Co-Authors: Meenakshi Ramphul, Mairead Kennelly, Gerard Burke, Soha Said, Alan A Montgomery, Deidre Murphy
    Abstract:

    Objective To determine whether the use of ultrasound can reduce the incidence of incorrect diagnosis of the fetal head position at Instrumental Delivery and subsequent morbidity. Design Two-arm, parallel, randomised trial, conducted from June 2011 to December 2012. Setting Two maternity hospitals in the Republic of Ireland. Sample A cohort of 514 nulliparous women at term (≥37 weeks of gestation) with singleton cephalic pregnancies, aiming to deliver vaginally, were recruited prior to an induction of labour or in early labour. Methods If Instrumental Delivery was required, women who had provided written consent were randomised to receive clinical assessment (standard care) or ultrasound scan and clinical assessment (ultrasound). [Correction added on 17 April 2014, after first online publication: Sentence was amended.] Main outcome measure Incorrect diagnosis of the fetal head position. Results The incidence of incorrect diagnosis was significantly lower in the ultrasound group than the standard care group (4/257, 1.6%, versus 52/257, 20.2%; odds ratio 0.06; 95% confidence interval 0.02–0.19; P < 0.001). The decision to Delivery interval was similar in both groups (ultrasound mean 13.8 minutes, SD 8.7 minutes, versus standard care mean 14.6 minutes, SD 10.1 minutes, P = 0.35). The incidence of maternal and neonatal complications, failed Instrumental Delivery, and caesarean section was not significantly different between the two groups. Conclusions An ultrasound assessment prior to Instrumental Delivery reduced the incidence of incorrect diagnosis of the fetal head position without delaying Delivery, but did not prevent morbidity. A more integrated clinical skills-based approach is likely to be required to prevent adverse outcomes at Instrumental Delivery.

  • Instrumental Delivery and ultrasound : a multicentre randomised controlled trial of ultrasound assessment of the fetal head position versus standard care as an approach to prevent morbidity at Instrumental Delivery.
    BJOG : an international journal of obstetrics and gynaecology, 2014
    Co-Authors: Meenakshi Ramphul, Mairead Kennelly, Gerard Burke, Alan A Montgomery, Poh Vei Ooi, Soha A.t. Said, Deidre J. Murphy
    Abstract:

    Objective To determine whether the use of ultrasound can reduce the incidence of incorrect diagnosis of the fetal head position at Instrumental Delivery and subsequent morbidity. Design Two-arm, parallel, randomised trial, conducted from June 2011 to December 2012. Setting Two maternity hospitals in the Republic of Ireland. Sample A cohort of 514 nulliparous women at term (≥37 weeks of gestation) with singleton cephalic pregnancies, aiming to deliver vaginally, were recruited prior to an induction of labour or in early labour. Methods If Instrumental Delivery was required, women who had provided written consent were randomised to receive clinical assessment (standard care) or ultrasound scan and clinical assessment (ultrasound). [Correction added on 17 April 2014, after first online publication: Sentence was amended.] Main outcome measure Incorrect diagnosis of the fetal head position. Results The incidence of incorrect diagnosis was significantly lower in the ultrasound group than the standard care group (4/257, 1.6%, versus 52/257, 20.2%; odds ratio 0.06; 95% confidence interval 0.02–0.19; P 

  • Study Protocol. IDUS - Instrumental Delivery & ultrasound. A multi-centre randomised controlled trial of ultrasound assessment of the fetal head position versus standard care as an approach to prevent morbidity at Instrumental Delivery
    BMC pregnancy and childbirth, 2012
    Co-Authors: Deirdre J. Murphy, Gerard Burke, Alan A Montgomery, Meenakshi Ramphul
    Abstract:

    Background: Instrumental deliveries are commonly performed in the United Kingdom and Ireland, with rates of 12 – 17% in most centres. Knowing the exact position of the fetal head is a pre-requisite for safe Instrumental Delivery. Traditionally, diagnosis of the fetal head position is made on transvaginal digital examination by delineating the suture lines of the fetal skull and the fontanelles. However, the accuracy of transvaginal digital examination can be unreliable and varies between 20% and 75%. Failure to identify the correct fetal head position increases the likelihood of failed Instrumental Delivery with the additional morbidity of sequential use of instruments or second stage caesarean section. The use of ultrasound in determining the position of the fetal head has been explored but is not part of routine clinical practice. Methods/Design: A multi-centre randomised controlled trial is proposed. The study will take place in two large maternity units in Ireland with a combined annual birth rate of 13,500 deliveries. It will involve 450 nulliparous women undergoing Instrumental Delivery after 37 weeks gestation. The main outcome measure will be incorrect diagnosis of the fetal head position. A study involving 450 women will have 80% power to detect a 10% difference in the incidence of inaccurate diagnosis of the fetal head position with two-sided 5% alpha. Discussion: It is both important and timely to evaluate the use of ultrasound to diagnose the fetal head position prior to Instrumental Delivery before routine use can be advocated. The overall aim is to reduce the incidence of incorrect diagnosis of the fetal head position prior to Instrumental Delivery and improve the safety of Instrumental deliveries.

  • study protocol idus Instrumental Delivery ultrasound a multi centre randomised controlled trial of ultrasound assessment of the fetal head position versus standard care as an approach to prevent morbidity at Instrumental Delivery
    BMC Pregnancy and Childbirth, 2012
    Co-Authors: Deirdre J. Murphy, Gerard Burke, Alan A Montgomery, Meenakshi Ramphul
    Abstract:

    Background: Instrumental deliveries are commonly performed in the United Kingdom and Ireland, with rates of 12 – 17% in most centres. Knowing the exact position of the fetal head is a pre-requisite for safe Instrumental Delivery. Traditionally, diagnosis of the fetal head position is made on transvaginal digital examination by delineating the suture lines of the fetal skull and the fontanelles. However, the accuracy of transvaginal digital examination can be unreliable and varies between 20% and 75%. Failure to identify the correct fetal head position increases the likelihood of failed Instrumental Delivery with the additional morbidity of sequential use of instruments or second stage caesarean section. The use of ultrasound in determining the position of the fetal head has been explored but is not part of routine clinical practice. Methods/Design: A multi-centre randomised controlled trial is proposed. The study will take place in two large maternity units in Ireland with a combined annual birth rate of 13,500 deliveries. It will involve 450 nulliparous women undergoing Instrumental Delivery after 37 weeks gestation. The main outcome measure will be incorrect diagnosis of the fetal head position. A study involving 450 women will have 80% power to detect a 10% difference in the incidence of inaccurate diagnosis of the fetal head position with two-sided 5% alpha. Discussion: It is both important and timely to evaluate the use of ultrasound to diagnose the fetal head position prior to Instrumental Delivery before routine use can be advocated. The overall aim is to reduce the incidence of incorrect diagnosis of the fetal head position prior to Instrumental Delivery and improve the safety of Instrumental deliveries.

Gerard Burke - One of the best experts on this subject based on the ideXlab platform.

  • Risk factors and morbidity associated with suboptimal instrument placement at Instrumental Delivery: observational study nested within the Instrumental Delivery & Ultrasound randomised controlled trial ISRCTN 72230496
    BJOG : an international journal of obstetrics and gynaecology, 2014
    Co-Authors: Meenakshi Ramphul, Mairead Kennelly, Gerard Burke, Deirdre J. Murphy
    Abstract:

    Objectives To identify risk factors and morbidity associated with suboptimal instrument placement at Instrumental Delivery. Design Observational study, nested within a randomised controlled trial. Setting Two university-affiliated maternity hospitals. Sample A cohort of 478 nulliparous women at term (≥37 weeks of gestation) undergoing Instrumental Delivery. Methods Univariable and multivariable logistic regression analyses were performed. Main outcome measures Risk factors for suboptimal application of vacuum or forceps, maternal and neonatal morbidity, and the sequential use of instruments, second operator, and caesarean section following failed Instrumental Delivery. Results Instrument placement was suboptimal in 138 of 478 (28.8%) deliveries. Factors associated with suboptimal instrument placement included fetal malposition (OR 2.44, 95% CI 1.62–3.66), mid-cavity station (OR 1.68, 95% CI 1.02–2.78), and forceps as the primary instrument (OR 2.01, 95% CI 1.33–3.04). Compared with optimal instrument placement, suboptimal placement was associated with prolonged hospital stay (adjusted OR 2.28, 95% CI 1.30–4.02) and neonatal trauma (adjusted OR 4.25, 95% CI 1.85–9.72). Suboptimal placement was associated with a greater use of sequential instruments (adjusted OR 3.99, 95% CI 1.94–8.23) and caesarean section for failed Instrumental Delivery (adjusted OR 3.81, 95% CI 1.10–13.16). The mean decision to Delivery interval (DDI) was 4 minutes longer in the suboptimal group (95% CI 2.1–5.9 minutes). Conclusions Suboptimal instrument placement is associated with increased maternal and neonatal morbidity and procedural complications. Greater attention should be focused on instrument placement when training obstetricians for Instrumental Delivery.

  • Instrumental Delivery and ultrasound a multicentre randomised controlled trial of ultrasound assessment of the fetal head position versus standard care as an approach to prevent morbidity at Instrumental Delivery
    British Journal of Obstetrics and Gynaecology, 2014
    Co-Authors: Meenakshi Ramphul, Mairead Kennelly, Gerard Burke, Soha Said, Alan A Montgomery, Deidre Murphy
    Abstract:

    Objective To determine whether the use of ultrasound can reduce the incidence of incorrect diagnosis of the fetal head position at Instrumental Delivery and subsequent morbidity. Design Two-arm, parallel, randomised trial, conducted from June 2011 to December 2012. Setting Two maternity hospitals in the Republic of Ireland. Sample A cohort of 514 nulliparous women at term (≥37 weeks of gestation) with singleton cephalic pregnancies, aiming to deliver vaginally, were recruited prior to an induction of labour or in early labour. Methods If Instrumental Delivery was required, women who had provided written consent were randomised to receive clinical assessment (standard care) or ultrasound scan and clinical assessment (ultrasound). [Correction added on 17 April 2014, after first online publication: Sentence was amended.] Main outcome measure Incorrect diagnosis of the fetal head position. Results The incidence of incorrect diagnosis was significantly lower in the ultrasound group than the standard care group (4/257, 1.6%, versus 52/257, 20.2%; odds ratio 0.06; 95% confidence interval 0.02–0.19; P < 0.001). The decision to Delivery interval was similar in both groups (ultrasound mean 13.8 minutes, SD 8.7 minutes, versus standard care mean 14.6 minutes, SD 10.1 minutes, P = 0.35). The incidence of maternal and neonatal complications, failed Instrumental Delivery, and caesarean section was not significantly different between the two groups. Conclusions An ultrasound assessment prior to Instrumental Delivery reduced the incidence of incorrect diagnosis of the fetal head position without delaying Delivery, but did not prevent morbidity. A more integrated clinical skills-based approach is likely to be required to prevent adverse outcomes at Instrumental Delivery.

  • Instrumental Delivery and ultrasound : a multicentre randomised controlled trial of ultrasound assessment of the fetal head position versus standard care as an approach to prevent morbidity at Instrumental Delivery.
    BJOG : an international journal of obstetrics and gynaecology, 2014
    Co-Authors: Meenakshi Ramphul, Mairead Kennelly, Gerard Burke, Alan A Montgomery, Poh Vei Ooi, Soha A.t. Said, Deidre J. Murphy
    Abstract:

    Objective To determine whether the use of ultrasound can reduce the incidence of incorrect diagnosis of the fetal head position at Instrumental Delivery and subsequent morbidity. Design Two-arm, parallel, randomised trial, conducted from June 2011 to December 2012. Setting Two maternity hospitals in the Republic of Ireland. Sample A cohort of 514 nulliparous women at term (≥37 weeks of gestation) with singleton cephalic pregnancies, aiming to deliver vaginally, were recruited prior to an induction of labour or in early labour. Methods If Instrumental Delivery was required, women who had provided written consent were randomised to receive clinical assessment (standard care) or ultrasound scan and clinical assessment (ultrasound). [Correction added on 17 April 2014, after first online publication: Sentence was amended.] Main outcome measure Incorrect diagnosis of the fetal head position. Results The incidence of incorrect diagnosis was significantly lower in the ultrasound group than the standard care group (4/257, 1.6%, versus 52/257, 20.2%; odds ratio 0.06; 95% confidence interval 0.02–0.19; P 

  • Study Protocol. IDUS - Instrumental Delivery & ultrasound. A multi-centre randomised controlled trial of ultrasound assessment of the fetal head position versus standard care as an approach to prevent morbidity at Instrumental Delivery
    BMC pregnancy and childbirth, 2012
    Co-Authors: Deirdre J. Murphy, Gerard Burke, Alan A Montgomery, Meenakshi Ramphul
    Abstract:

    Background: Instrumental deliveries are commonly performed in the United Kingdom and Ireland, with rates of 12 – 17% in most centres. Knowing the exact position of the fetal head is a pre-requisite for safe Instrumental Delivery. Traditionally, diagnosis of the fetal head position is made on transvaginal digital examination by delineating the suture lines of the fetal skull and the fontanelles. However, the accuracy of transvaginal digital examination can be unreliable and varies between 20% and 75%. Failure to identify the correct fetal head position increases the likelihood of failed Instrumental Delivery with the additional morbidity of sequential use of instruments or second stage caesarean section. The use of ultrasound in determining the position of the fetal head has been explored but is not part of routine clinical practice. Methods/Design: A multi-centre randomised controlled trial is proposed. The study will take place in two large maternity units in Ireland with a combined annual birth rate of 13,500 deliveries. It will involve 450 nulliparous women undergoing Instrumental Delivery after 37 weeks gestation. The main outcome measure will be incorrect diagnosis of the fetal head position. A study involving 450 women will have 80% power to detect a 10% difference in the incidence of inaccurate diagnosis of the fetal head position with two-sided 5% alpha. Discussion: It is both important and timely to evaluate the use of ultrasound to diagnose the fetal head position prior to Instrumental Delivery before routine use can be advocated. The overall aim is to reduce the incidence of incorrect diagnosis of the fetal head position prior to Instrumental Delivery and improve the safety of Instrumental deliveries.

  • study protocol idus Instrumental Delivery ultrasound a multi centre randomised controlled trial of ultrasound assessment of the fetal head position versus standard care as an approach to prevent morbidity at Instrumental Delivery
    BMC Pregnancy and Childbirth, 2012
    Co-Authors: Deirdre J. Murphy, Gerard Burke, Alan A Montgomery, Meenakshi Ramphul
    Abstract:

    Background: Instrumental deliveries are commonly performed in the United Kingdom and Ireland, with rates of 12 – 17% in most centres. Knowing the exact position of the fetal head is a pre-requisite for safe Instrumental Delivery. Traditionally, diagnosis of the fetal head position is made on transvaginal digital examination by delineating the suture lines of the fetal skull and the fontanelles. However, the accuracy of transvaginal digital examination can be unreliable and varies between 20% and 75%. Failure to identify the correct fetal head position increases the likelihood of failed Instrumental Delivery with the additional morbidity of sequential use of instruments or second stage caesarean section. The use of ultrasound in determining the position of the fetal head has been explored but is not part of routine clinical practice. Methods/Design: A multi-centre randomised controlled trial is proposed. The study will take place in two large maternity units in Ireland with a combined annual birth rate of 13,500 deliveries. It will involve 450 nulliparous women undergoing Instrumental Delivery after 37 weeks gestation. The main outcome measure will be incorrect diagnosis of the fetal head position. A study involving 450 women will have 80% power to detect a 10% difference in the incidence of inaccurate diagnosis of the fetal head position with two-sided 5% alpha. Discussion: It is both important and timely to evaluate the use of ultrasound to diagnose the fetal head position prior to Instrumental Delivery before routine use can be advocated. The overall aim is to reduce the incidence of incorrect diagnosis of the fetal head position prior to Instrumental Delivery and improve the safety of Instrumental deliveries.

Alan A Montgomery - One of the best experts on this subject based on the ideXlab platform.

  • Instrumental Delivery and ultrasound a multicentre randomised controlled trial of ultrasound assessment of the fetal head position versus standard care as an approach to prevent morbidity at Instrumental Delivery
    British Journal of Obstetrics and Gynaecology, 2014
    Co-Authors: Meenakshi Ramphul, Mairead Kennelly, Gerard Burke, Soha Said, Alan A Montgomery, Deidre Murphy
    Abstract:

    Objective To determine whether the use of ultrasound can reduce the incidence of incorrect diagnosis of the fetal head position at Instrumental Delivery and subsequent morbidity. Design Two-arm, parallel, randomised trial, conducted from June 2011 to December 2012. Setting Two maternity hospitals in the Republic of Ireland. Sample A cohort of 514 nulliparous women at term (≥37 weeks of gestation) with singleton cephalic pregnancies, aiming to deliver vaginally, were recruited prior to an induction of labour or in early labour. Methods If Instrumental Delivery was required, women who had provided written consent were randomised to receive clinical assessment (standard care) or ultrasound scan and clinical assessment (ultrasound). [Correction added on 17 April 2014, after first online publication: Sentence was amended.] Main outcome measure Incorrect diagnosis of the fetal head position. Results The incidence of incorrect diagnosis was significantly lower in the ultrasound group than the standard care group (4/257, 1.6%, versus 52/257, 20.2%; odds ratio 0.06; 95% confidence interval 0.02–0.19; P < 0.001). The decision to Delivery interval was similar in both groups (ultrasound mean 13.8 minutes, SD 8.7 minutes, versus standard care mean 14.6 minutes, SD 10.1 minutes, P = 0.35). The incidence of maternal and neonatal complications, failed Instrumental Delivery, and caesarean section was not significantly different between the two groups. Conclusions An ultrasound assessment prior to Instrumental Delivery reduced the incidence of incorrect diagnosis of the fetal head position without delaying Delivery, but did not prevent morbidity. A more integrated clinical skills-based approach is likely to be required to prevent adverse outcomes at Instrumental Delivery.

  • Instrumental Delivery and ultrasound : a multicentre randomised controlled trial of ultrasound assessment of the fetal head position versus standard care as an approach to prevent morbidity at Instrumental Delivery.
    BJOG : an international journal of obstetrics and gynaecology, 2014
    Co-Authors: Meenakshi Ramphul, Mairead Kennelly, Gerard Burke, Alan A Montgomery, Poh Vei Ooi, Soha A.t. Said, Deidre J. Murphy
    Abstract:

    Objective To determine whether the use of ultrasound can reduce the incidence of incorrect diagnosis of the fetal head position at Instrumental Delivery and subsequent morbidity. Design Two-arm, parallel, randomised trial, conducted from June 2011 to December 2012. Setting Two maternity hospitals in the Republic of Ireland. Sample A cohort of 514 nulliparous women at term (≥37 weeks of gestation) with singleton cephalic pregnancies, aiming to deliver vaginally, were recruited prior to an induction of labour or in early labour. Methods If Instrumental Delivery was required, women who had provided written consent were randomised to receive clinical assessment (standard care) or ultrasound scan and clinical assessment (ultrasound). [Correction added on 17 April 2014, after first online publication: Sentence was amended.] Main outcome measure Incorrect diagnosis of the fetal head position. Results The incidence of incorrect diagnosis was significantly lower in the ultrasound group than the standard care group (4/257, 1.6%, versus 52/257, 20.2%; odds ratio 0.06; 95% confidence interval 0.02–0.19; P 

  • Study Protocol. IDUS - Instrumental Delivery & ultrasound. A multi-centre randomised controlled trial of ultrasound assessment of the fetal head position versus standard care as an approach to prevent morbidity at Instrumental Delivery
    BMC pregnancy and childbirth, 2012
    Co-Authors: Deirdre J. Murphy, Gerard Burke, Alan A Montgomery, Meenakshi Ramphul
    Abstract:

    Background: Instrumental deliveries are commonly performed in the United Kingdom and Ireland, with rates of 12 – 17% in most centres. Knowing the exact position of the fetal head is a pre-requisite for safe Instrumental Delivery. Traditionally, diagnosis of the fetal head position is made on transvaginal digital examination by delineating the suture lines of the fetal skull and the fontanelles. However, the accuracy of transvaginal digital examination can be unreliable and varies between 20% and 75%. Failure to identify the correct fetal head position increases the likelihood of failed Instrumental Delivery with the additional morbidity of sequential use of instruments or second stage caesarean section. The use of ultrasound in determining the position of the fetal head has been explored but is not part of routine clinical practice. Methods/Design: A multi-centre randomised controlled trial is proposed. The study will take place in two large maternity units in Ireland with a combined annual birth rate of 13,500 deliveries. It will involve 450 nulliparous women undergoing Instrumental Delivery after 37 weeks gestation. The main outcome measure will be incorrect diagnosis of the fetal head position. A study involving 450 women will have 80% power to detect a 10% difference in the incidence of inaccurate diagnosis of the fetal head position with two-sided 5% alpha. Discussion: It is both important and timely to evaluate the use of ultrasound to diagnose the fetal head position prior to Instrumental Delivery before routine use can be advocated. The overall aim is to reduce the incidence of incorrect diagnosis of the fetal head position prior to Instrumental Delivery and improve the safety of Instrumental deliveries.

  • study protocol idus Instrumental Delivery ultrasound a multi centre randomised controlled trial of ultrasound assessment of the fetal head position versus standard care as an approach to prevent morbidity at Instrumental Delivery
    BMC Pregnancy and Childbirth, 2012
    Co-Authors: Deirdre J. Murphy, Gerard Burke, Alan A Montgomery, Meenakshi Ramphul
    Abstract:

    Background: Instrumental deliveries are commonly performed in the United Kingdom and Ireland, with rates of 12 – 17% in most centres. Knowing the exact position of the fetal head is a pre-requisite for safe Instrumental Delivery. Traditionally, diagnosis of the fetal head position is made on transvaginal digital examination by delineating the suture lines of the fetal skull and the fontanelles. However, the accuracy of transvaginal digital examination can be unreliable and varies between 20% and 75%. Failure to identify the correct fetal head position increases the likelihood of failed Instrumental Delivery with the additional morbidity of sequential use of instruments or second stage caesarean section. The use of ultrasound in determining the position of the fetal head has been explored but is not part of routine clinical practice. Methods/Design: A multi-centre randomised controlled trial is proposed. The study will take place in two large maternity units in Ireland with a combined annual birth rate of 13,500 deliveries. It will involve 450 nulliparous women undergoing Instrumental Delivery after 37 weeks gestation. The main outcome measure will be incorrect diagnosis of the fetal head position. A study involving 450 women will have 80% power to detect a 10% difference in the incidence of inaccurate diagnosis of the fetal head position with two-sided 5% alpha. Discussion: It is both important and timely to evaluate the use of ultrasound to diagnose the fetal head position prior to Instrumental Delivery before routine use can be advocated. The overall aim is to reduce the incidence of incorrect diagnosis of the fetal head position prior to Instrumental Delivery and improve the safety of Instrumental deliveries.

C P Lee - One of the best experts on this subject based on the ideXlab platform.

  • Continued reduction in the incidence of birth trauma and birth asphyxia related to Instrumental deliveries after the study period: was this the Hawthorne effect?
    European journal of obstetrics gynecology and reproductive biology, 2006
    Co-Authors: W C Leung, B C P Chan, K W Lam, K Y Leung, T C Pun, T T Lao, C P Lee
    Abstract:

    The incidence of birth trauma and birth asphyxia related to Instrumental deliveries in our obstetric unit was high (2.8%) in 1998-1999. A study was performed in 2000 to identify the risk factors. Unexpectedly, the incidence (0.6%) was reduced significantly during the study period. We attributed this phenomenon to the famous Hawthorne effect (tendency to improve performance because of awareness of being studied). The objectives were to study whether there is a continued reduction in the incidence of birth trauma and birth asphyxia related to Instrumental deliveries in the post-study period (2001-2003) and to investigate the presence of underlying confounding factors apart from the Hawthorne effect. To compare the hospital obstetric statistics among the pre-study period (1998-1999), the study period (2000) and the post-study period (2001-2003), in particular the incidence of birth trauma and birth asphyxia related to Instrumental deliveries, the Instrumental Delivery rate, the overall Caesarean section rate, the Caesarean section rate for no progress of labour, the incidence of failed Instrumental Delivery, the incidence of attempted Instrumental Delivery in the operating theatre, and incidence of direct second-stage Caesarean sections. The incidence of birth trauma and birth asphyxia related to Instrumental deliveries (0.6%) during the study period (2000) was significantly lower than that (2.8%) during the pre-study period (1998-1999; RR 0.27, 95% CI 0.11-0.70). This phenomenon continued into the post-study period (2001-2003) when the incidence of 1.0% was similarly lower than that in the pre-study period (RR 0.35, 95% CI 0.20-0.64). The Instrumental Delivery rate decreased further in the post-study period (13.5%) compared with those in the study (16.6%) and pre-study (19.5%) periods (RR 0.81, 95% CI 0.75-0.89 and RR 0.69, 95% CI 0.65-0.74, respectively). There was a marked increase in the direct second-stage Caesarean section rate in the post-study period (7.1%) compared to those in the study (0.4%) and pre-study (0.7%) periods (RR 15.9, 95% CI 5.05-49.73 and RR 9.77, 95% CI 5.28-18.08, respectively). A change in obstetric practice was identified that may explain the continued reduction in the incidence of birth trauma and birth asphyxia related to Instrumental deliveries in the post-study period.

  • unexpected reduction in the incidence of birth trauma and birth asphyxia related to Instrumental deliveries during the study period was this the hawthorne effect
    European Journal of Obstetrics & Gynecology and Reproductive Biology, 2003
    Co-Authors: W C Leung, K W Lam, H S W Lam, C P Lee
    Abstract:

    Abstract Background The incidence of birth trauma and birth asphyxia related to Instrumental deliveries in our obstetric unit was high (2.8%) in 1998–1999. A study was performed in 2000 to identify the risk factors. Unexpectedly, the incidence (0.6%) was reduced significantly during the study period. We attributed this phenomenon to the famous Hawthorne effect (tendency to improve performance because of awareness of being studied). Objectives The objectives were to study whether there is a continued reduction in the incidence of birth trauma and birth asphyxia related to Instrumental deliveries in the post-study period (2001–2003) and to investigate the presence of underlying confounding factors apart from the Hawthorne effect. Method To compare the hospital obstetric statistics among the pre-study period (1998–1999), the study period (2000) and the post-study period (2001–2003), in particular the incidence of birth trauma and birth asphyxia related to Instrumental deliveries, the Instrumental Delivery rate, the overall Caesarean section rate, the Caesarean section rate for no progress of labour, the incidence of failed Instrumental Delivery, the incidence of attempted Instrumental Delivery in the operating theatre, and incidence of direct second-stage Caesarean sections. Results The incidence of birth trauma and birth asphyxia related to Instrumental deliveries (0.6%) during the study period (2000) was significantly lower than that (2.8%) during the pre-study period (1998–1999; RR 0.27, 95% CI 0.11–0.70). This phenomenon continued into the post-study period (2001–2003) when the incidence of 1.0% was similarly lower than that in the pre-study period (RR 0.35, 95% CI 0.20–0.64). The Instrumental Delivery rate decreased further in the post-study period (13.5%) compared with those in the study (16.6%) and pre-study (19.5%) periods (RR 0.81, 95% CI 0.75–0.89 and RR 0.69, 95% CI 0.65–0.74, respectively). There was a marked increase in the direct second-stage Caesarean section rate in the post-study period (7.1%) compared to those in the study (0.4%) and pre-study (0.7%) periods (RR 15.9, 95% CI 5.05–49.73 and RR 9.77, 95% CI 5.28–18.08, respectively). Conclusion A change in obstetric practice was identified that may explain the continued reduction in the incidence of birth trauma and birth asphyxia related to Instrumental deliveries in the post-study period.

  • Unexpected reduction in the incidence of birth trauma and birth asphyxia related to Instrumental deliveries during the study period: was this the Hawthorne effect?
    BJOG : an international journal of obstetrics and gynaecology, 2003
    Co-Authors: W C Leung, K W Lam, H S W Lam, C P Lee
    Abstract:

    The study was originally designed to identify the risk factors that could predict those difficult Instrumental deliveries resulting in birth trauma and birth asphyxia. A prospective study on all singleton deliveries in cephalic presentation with an attempt of Instrumental Delivery over a 12-month period (13 March 2000 to 12 March 2001). A local teaching hospital. Six hundred and seventy deliveries. A codesheet was designed to record the demographic data, characteristics of first and second stages of labour and neonatal outcome. In particular, the doctor had to enter the pelvic examination findings before the attempt of Instrumental Delivery. Birth trauma and birth asphyxia. There was a significant reduction in the incidence of birth trauma and birth asphyxia related to Instrumental deliveries during the study period (0.6%) when compared with that (2.8%) in the pre-study period (1998 and 1999) (RR 0.27, 95% CI 0.11-0.70). There was more trial of Instrumental deliveries in the operating theatre although this was not statistically significant (RR 1.19, 95% CI 0.88-1.60). The Instrumental Delivery rate decreased during the study period (RR 0.88, 95% CI 0.82-0.94). The caesarean section rate for no progress of labour, the incidence of direct second stage caesarean section and the incidence of failed Instrumental Delivery did not increase during the study period. Apart from the merits of regular audit exercise and increasing experience of the staff, the Hawthorne effect might be the major contributing factor in the reduction of birth trauma and birth asphyxia related to Instrumental deliveries during the study period.